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Women in preterm labour ‘need antibiotics to combat Strep B’

All women who go into premature labour should be offered antibiotics, as a matter of course, to help prevent Group B Streptococcal infection, according to updated expert guidance.

The revised guidance, from the Royal College of Obstetricians and Gynaecologists, comes amid a rise in cases of the infection in newborns and concern about wide variations in practice on prevention.

“This guidance provides clear advice to doctors and midwives on which women should be offered antibiotics”

Peter Brocklehurst

As well as new recommendations on antibiotic treatment, the college also called for better information for women, with the ultimate goal of reducing early onset Group B Strep infections and neonatal deaths.

Group B Strep, a bacteria that occurs naturally in the digestive system and lower vaginal tract in about a quarter of women, can be passed onto a baby during labour, noted the RCOG.

While the vast majority suffer no ill effects, some babies will develop an infection and can become seriously ill with one in 20 dying, the college highlighted.

The risk of infection is greater for those born prematurely, so the guidance recommends all women who go into preterm labour – regardless of whether their waters have broken – get IV antibiotics.

Other risk factors for early onset Group B Strep include having had a previous baby affected by the infection, a positive test for it, prolonged rupture of membranes and a temperature of more than 38 degrees during labour.

The guidance said women who were known carriers of Group B Strep in a previous pregnancy could be offered a test at 35 to 37 weeks, to see if they were still a carrier and to help assess the need for antibiotics during labour.

However, it does not recommend blanket screening for all women, as there was no clear evidence to show routine testing would do more good than harm.

Peter Brocklehurst, professor of women’s health at the University of Birmingham and a co-author of the guideline, said it was vital to ensure a consistent approach to risk management in all maternity units, in order to get the best outcomes for mothers and babies.

Women in preterm labour ‘need antibiotics to combat Strep B’

Peter Brocklehurst

“This guidance provides clear advice to doctors and midwives on which women should be offered antibiotics to avoid passing Group B Strep infection onto their babies,” he said.

“In particular, we hope to reduce the number of early onset Group B Strep infections and neonatal deaths in babies born before 37 weeks,” noted Professor Brocklehurst.

He added: “The management of women whose babies are at raised risk of developing Group B Strep infection remains a vital part of reducing illness and deaths caused by this infection.”

Incidence of early onset Group B Strep appears to be rising in the UK, with about 500 babies developing the condition in 2015.

However, research by the RCOG found wide variation in practice when it came to prevention.

“This revised guideline will provide standardised treatment of pregnant women with Group B Strep and reduce the risk of their babies developing the infection,” said Professor Janice Rymer, the RCPG’s vice president of education.

“The guideline also aims to raise awareness of Group B Strep by recommending that all pregnant women are provided with an appropriate information leaflet,” she said.

“When fully implemented across the UK, we believe this change will make a real difference”

Jane Plumb

The college is producing an updated version of its leaflet about Group B Strep for expectant mums and their partners, which includes information about the signs and symptoms of infection in babies.

National charity Group B Strep Support has been involved in devising the leaflet.

“We are confident that this increased access to clear, concise information will play a vital role in raising awareness of Group B Strep and empowering women to make informed decisions throughout their pregnancy and in the early days after birth,” said its chief executive Jane Plumb.

Overall, she welcomed the updated guidance, which she described as a “significant improvement”.

“When fully implemented across the UK, we believe this change will make a real difference and we will see the rate of infection start to fall,” she said.

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